“By Morton Thompson?”
“The very fellah. It’s about a nineteenth-century Viennese obstetrician called Semmelweis who made all his students wash their dirty hands in a solution of chloride of lime before they delivered a woman . . .”
“And he cut the mortality rate from childbirth fever from about one in ten to less than two percent . . .”
“And because he challenged the medical establishment of the time, they destroyed him. But he was right.” O’Reilly parked himself in his chair. “Sometimes,” he said, “sometimes I think we could use a few more like Semmelweiss to challenge the establishment.” He scratched his head. “Enough philosophy. You haven’t answered my question.”
Being momentarily distracted by O’Reilly’s observations had allowed the same mysterious meshing of Barry’s mental gears that often helped him solve crossword puzzles.
“I have it,” he said, grinning.
“And no doubt penicillin cures it. Would you mind letting me in on the secret?”
“She’s almost certainly got Myasthenia gravis.”
O’Reilly whistled. “I don’t believe I’ve ever seen a case. It’s rare as a hen’s teeth.”
It was all coming back. Barry rattled off what he had remembered. “A disease afflicting neuromuscular transmission. Characterized by fatigue of striped muscle and rapid recovery after a period of rest.”
“You showed she’s got that all right.”
Barry carried on. “Hardly if ever fatal, but very debilitating. The symptoms may rarely be associated with thyrotoxicosis and with carcinomatous neuropathy.”
“That’s right . . . but I don’t think a woman of that size could be riddled with cancer, do you?”
“I doubt it very much. And she’s no other symptoms.”
“So we can rule out a cancer somewhere?”
Barry hesitated. He’d made one mistake with Major Fotheringham by making assumptions that had turned out to be wrong. “Give me a minute, Fingal. Carcinomatous neuropathy doesn’t usually show up until the cancer is really advanced, usually way past being treatable. Any patient that sick would be skin and bone by now . . .”
“Hardly Flo Bishop . . .”
“And if I’m wrong”—he swallowed—“she’s beyond our help anyway.”
“Some of them are,” O’Reilly said quietly.
“I think we should concentrate on trying to find out if she has something we can help.”
“Agreed . . . but we should have her thyroid hormone levels measured. Just to be sure about that.”
“Right. And for primary Myasthenia there’s a simple test we can do right here in the surgery, but I can’t remember exactly what it is,” he said. “I could go up to Belfast and have a word with Professor Faulkner at the Royal—”
“Why not just phone him?”
“Professor Faulkner never takes phone calls, at least not from very junior doctors, but I could catch him after he makes his ward rounds on Wednesday afternoon.”
“You go right ahead. I’ll look after the shop while you’re away,” O’Reilly said. He stood and shook Barry’s hand. “If you’re right, son, it’ll be Laverty ten, Bishop nil . . . and it’ll work wonders for your reputation. I’ll see to that.”
Barry refrained from asking how, but he relished the thought of discomfiting the arrogant little man. “I’d not mind putting one over the dear councillor.” He laughed.
“You laugh away, son,” said O’Reilly, “but remember, ‘A man that studieth revenge keeps his own wounds green.’ ”
“You’ve lost me on that one, Fingal.”
“It’s from an essay by Francis Bacon called ‘Of Revenge.’ ” There was a twinkle in O’Reilly’s brown eyes. Barry knew that just because he had made the diagnosis first, the older man wasn’t going to let him forget that “not all of us country GPs are entirely unlettered.” It was all very well to be mentally patting himself on the back, but the question remained, was he right?
“You don’t mind me taking over her management?”
O’Reilly laughed. “It’s your case, Barry. You do as you see fit.”
“Thanks, Fingal.”
“Huh. Never mind thanks. Nip along . . .”
“I know, and see who’s next.” Barry headed for the door, somehow feeling less like a glorified receptionist, quite happy to do O’Reilly’s bidding. As he walked out the door he heard O’Reilly musing, “I wonder what Bertie Bishop meant about getting things sorted out at the Black Swan?”
Her Rash Hand in Evil Hour
Barry ushered an elderly woman out through the surgery door. After the Bishops left, the morning had flown by. O’Reilly had let Barry handle the work, but his presence in the surgery must have been reassuring to the patients. It certainly had been to Barry as he steadily worked through the morning’s caseload.
Boys with sniffles, sore muscles, seborrhoea, acne; men with arthritis, angina, haemorrhoids, upset stomachs. Mothers with fractious babies, difficulty breast-feeding; children with earaches; women with heavy periods, no periods, prolapse of the uterus. Most he could handle in the surgery, but he’d had to refer three people to specialists at the Royal Victoria: the man whose angina was worsening, the woman whose periods were so heavy she had developed anaemia, and the woman whose periods had stopped six months earlier, but who as far as Barry could determine, wasn’t pregnant.
As each seemed to accept his advice—and most of them were gracious when they did so—Barry’s confidence grew. Perhaps O’Reilly was right, that all Barry had to do was do his job to the best of his ability. He just wished that the results of Major Fotheringham’s postmortem would arrive soon, but he knew that the Home Office pathologists could not be rushed, and all deaths for which the doctor could not sign a death certificate automatically fell under their jurisdiction.
He opened the waiting room door. One last patient, a young woman, sat on a bench in front of the hideous, rose-pattern wallpaper, flipping through the pages of a dog-eared Woman’s Own. He guessed she was in her early twenties, a pretty, red-haired, freckled girl with emerald green eyes. She wore white cotton gloves, a short white raincoat, the cuffs of a long-sleeved blouse peeping out past the ends of the sleeves, and a tartan, ankle-length skirt.
Barry found that unusual. The short skirt, popularized by Courreges earlier in 1964, was all the rage with some young Ulsterwomen. Even so, the brief flirtation in June among London fashion circles with topless evening dresses had not caught on here. He smothered a smile.
“Morning,” he said. “Will you come with me, please?”
She rose. “Doctor Laverty?”
“That’s right.”
“Oh,” she said noncommittally, but followed him along the hall.
He let her precede him into the surgery.
“Come on in, Helen Hewitt,” he heard O’Reilly say. “Have a pew.”
She sat.
“Would you mind if I asked Doctor Laverty to take a look?”
Barry saw her blush and shake her head. His earlier hopes that perhaps he was gaining ground were rattled.
“Why?” he heard O’Reilly ask.
“I’m embarrassed, so I am.” She stared at the carpet.
O’Reilly stood and put a hand under her chin, raising her head until she had to look into his eyes. “I know, Helen,” he said, “but I’d guess what I’ve been giving you isn’t working.”
Barry saw her green eyes grow moist.
“That’s right,” she whispered.
O’Reilly glanced over his half-moons at Barry before saying, “Doctor Laverty may have some new ideas.”
She half turned, stared at Barry, and glanced back to O’Reilly like a little girl seeking reassurance from her mother. Then she said quietly, “I suppose so.” She took off her raincoat and gloves and rolled up one of her long sleeves. She stretched her arm to Barry and pointed at the hollow in front of her elbow. “It’s that there,” she said.
Barry bent forward. Her lower arm was, like her face, frec
kled. There was a rash in the antecubital fossa and on the skin of her palm. It was angry red, weeping, and scaly.
“It itches something ferocious,” she said.
“And is it the same on the other side, and behind your knees?” he asked.
She nodded.
That would explain the gloves, the long sleeves, and the ankle-length dress. She’d be too ashamed to let people see her disfigurement. No wonder she’d not wanted to show it to Barry.
“You’ve got eczema,” he said. He saw O’Reilly nod. Eczema, Barry thought, running through a mental checklist. “How long have you had it?”
“About two months.”
So it wasn’t infantile eczema, which appeared in babyhood and was often accompanied by asthma.
“Have you changed your diet recently?”
“I’m not fat,” she said. “I’ve never been on a diet in my life.”
Barry heard the hint of anger in her voice and cursed himself for forgetting how literal the Ulster patient could be.
“I’m sorry,” he said. “I didn’t mean to suggest you were overweight . . .” He hesitated, wondering if he dare compliment her, and decided that he should. “You’ve a wonderful figure.”
“Aye. Well,” she said, sounding mollified. Was that a flicker of a smile?
“I just meant, have you been eating anything different recently?” Eczema could be caused by some foods and cosmetics.
“Not at all.”
“Helen and I have worked our way through her soaps, detergents, lipsticks, and nail varnishes,” O’Reilly added. “And she doesn’t use hair dye.”
“You don’t need to, you’ve beautiful hair,” Barry said. That took care of another set of possible causes.
Her smile broadened. “And Doctor O’Reilly made me stop wearing stockings . . .” She looked to O’Reilly for further reassurance. O’Reilly nodded. “And my bra.” She swallowed, clearly discomfited by having to reveal such personal details. “He said the nickel on the clips on it or on my suspender belt could be the cause.”
Despite himself, despite seven years of training, Barry suddenly had a vividly erotic image of the young woman wearing nothing but scanty lingerie and, worse, of Patricia similarly dressed. He coughed, reminded himself that doctors were human but were obliged to deal with their own feelings. He banished the disturbing thoughts and tried to concentrate. “I see.” He turned to O’Reilly. “Helen’s not had any penicillin or streptomycin?” As a student he had been admonished against overexposure to those antibiotics. Contact dermatitis was particularly prevalent among nurses and doctors.
“No,” said O’Reilly.
Barry hesitated. He’d been taught that some cases of eczema could be stress-related, but to raise the question, to suggest that someone might not be entirely in control, was fraught with risk. Any hint of mental illness was treated as the gravest insult by country folk. He recalled a woman who’d sworn blind that her husband was in jail rather than admit he was in a mental hospital. He tried to think of a tactful way to broach the subject, remembering how violently Maggie MacCorkle reacted when he first met her, suspected she was unhinged, and asked her if she had been hearing voices. He frowned, then said, “Has anything changed in your life in the last few months?” She couldn’t possibly be offended by that—could she?
“Aye,” Helen said. “I got a new job about three months ago.”
Interesting. “Would you like to tell me about it?” Surely O’Reilly would have found this out or even known about it before she had consulted him. There were very few secrets in Ballybucklebo.
“I went to work for Miss Moloney. In her dress shop.”
Hardly a stressful occupation. “How do you get along with her?” He saw fires burning in the depths of those green eyes.
“She’s an oul’ hoor, so she is. She has the personality of a bagful of hammers. She’s a holy terror and she hates the young ones. She’s a whey-faced oul’ nag-bag . . .” She covered her mouth with her hand.
Barry waited. He knew he’d struck the mother lode. The young woman remained silent, staring at the floor. He coaxed her gently. “It’s all right, Helen; whatever you say in here stays in here.”
Helen looked at Barry. “She’s driving me daft, so she is. Last week she caught me talking to Johnny Dougan. ‘Helen,’ say she, in her voice that would fillet a herring at ten fathoms, ‘come away from that person.’ She looked at Johnny as if he was something a boar’d thrown up in a pigsty. ‘I’m not paying you to stand round blethering all day. The hats need rearranging.’ They did not. Hadn’t I spent all morning doing that?”
“It doesn’t sound as if you’re very happy there.”
“Happy? I’d be happier hanging up by my thumbs.”
Barry looked at O’Reilly. Surely he must have known this. Why hadn’t he suggested she get another job?
“And don’t bother saying I should get another job,” she said. “Doctor O’Reilly’s already told me he thinks working with the old witch has given me this.” She pointed at the rash. “You said,” she half smiled at O’Reilly, “working with Miss Moloney would make a saint take the rickets.”
O’Reilly cleared his throat.
“So why not just leave?” It seemed simple to Barry.
“I wish I could, but I can’t do it.”
“Why not?”
“Wee Mary Dunleavy, Willy Dunleavy’s girl.”
Barry frowned. He recognized the name but didn’t recall seeing a patient called Willy. Willy? He’d got it. The licensee and barman at the Black Swan. The Bible, he thought, had a book called Numbers that detailed the genealogy of the Israelites. He just wished there was a similar publication to help him keep track of the interrelationships of the local citizenry.
“What’s Mary got to do with it?” he asked.
She sniffed. “Huh. Mary works part-time there. That Miss Moloney has a tongue on her like a drayman’s whip, so she has. She never leaves the poor wee girl alone. She has her in tears half the day. Sure I couldn’t leave wee Mary to face that by herself.”
“Why not?”
“She’s been looking for something else. She needs the money, but there’s not that many part-time jobs here and she can’t leave Ballybucklebo.”
“She can’t?”
“No, because her dad needs her to help out behind the bar, so he does. He can’t afford to take on a full-time barman until he knows what’s going to happen with the Duck.”
It was all getting too complicated for Barry. What the hell had a pub got to do with a young woman’s eczema?
“Oh.” Barry looked to O’Reilly, who held out both hands, palms up. Barry guessed what the big man was thinking. It seemed poor Helen was stuck. He asked, “What have you tried, Doctor O’Reilly?”
O’Reilly consulted no records. He simply said, “Calamine lotion when the rash first blew up, then Lassar’s paste—that’s zinc oxide with salicylic acid—and when it didn’t work, medical coal tar.” He shook his head. “By the look of your arm, Helen, the tar’s not doing a great deal either.”
That left only the newer hydrocortisone ointment, and even that would not get at what Barry was sure was the root cause. He made one more try. “Are you sure you couldn’t find work somewhere else?”
She shook her head vehemently. “Not as long as wee Mary’s there. And she will be as long as her da needs her.” She frowned. “Mind you, that might not be for much longer. She’s main scared someone’s trying to get ahold of the Duck and put her da out of a job, and that would be a calamity of the first magnitude. Then she’d have to ask Miss Moloney for a full-time job.”
“Why would she think someone was after the pub, Helen?” O’Reilly asked. Barry heard the seriousness in O’Reilly’s voice.
“Bedamned if I know, Doctor, but she told me her da was worried.”
“Mmm,” said O’Reilly. “Mmm.” He pulled off his spectacles and put a hand on her shoulder. “Never you mind about the old Duck,” he said. “You try not to let Miss Molo
ney upset you.”
“Aye, and no harm to you, Doctor, but you try to stop the tide coming in.”
“Fair enough.” O’Reilly laughed. “Now,” he said, “maybe Doctor Laverty here has a notion for a new ointment.”
Barry watched as she stared at him; then to his surprise she said, “Back there a wee while, Doctor Laverty, you was trying to puzzle out how to ask me if I was astray in the head, weren’t you?”
“Well, I—”
“And you were right tactful about it, so you were. So write you me the scrip, and I’ll give it a wee try.” She pulled down her sleeve and buttoned the cuff, rose, and waited until Barry filled in a prescription. “Thanks very much,” she said when he handed her the slip. “I’d be right glad to get rid of this here itch.” She rose.
“I can’t promise it’ll work,” Barry said.
“Sure don’t I know that? You’re only a doctor . . . not the sainted Jesus Christ almighty.”
Any feelings of pride Barry might have had for winning the young woman’s confidence were stifled, but, he told himself, her attitude wasn’t such a bad thing. At least her expectations were realistic. She’d be less disappointed if the results were poor—and less likely to blame him. “If I was, Helen, I’d chuck in my degree and go full-time into the laying-on-of-hands business.”
“Aye,” said O’Reilly, “and you could look forward to a bloody miserable Easter too.”
Barry heard Helen join him as he laughed at the older man’s irreverence. “Can you come back and see us in a month?” he asked.
“Aye, certainly, Doctor Laverty, but I’d better be running along now.” She curled her lip. “The Wicked Witch of the West’ll be having carniptions if I’m not back to give her a hand. She’s a wheen of new hats coming in for the ladies. There’ll be a brave few bought for Maggie MacCorkle’s wedding.”
“Right enough,” said O’Reilly as she left, “and for Donal Donnelly’s.” He hauled out his briar and lit up. “So,” he enquired, “how do you think the morning went?”
An Irish Country Village Page 10